There is little we know about treating concussions. The most important weapon in the fight against post-concussive syndrome is rest.

Returning a player too quickly to play can lead to serious consequences.  Witness Mikhail Grabovski, who went back into play right away after one hit, and stumbled badly on trying to get up from the ice after a second hit.  It’s been reported that he denied any symptoms to his trainer, and that’s the reason he was sent back out.  The fact he went on to score the winning goal is in fact terrible – he’s  been hailed as a trooper, coming back quickly from these hits to make a great play, but after the so-called Grabovski Wobble, he should never have returned to play.  We’ll have to see what sort of aftermath might ensue as a consequence of his injury, though Brian Burke maintains Grabovski never sustained a concussion.

There are lots of pressures that a professional athlete feels in a situation like this.  But for the rest of us, there isn’t so much riding on every play.  Being conservative is the wisest thing.  The attendees at the consensus conference in Zurich in 2008 concluded that no youth athlete should be returned to play on the same day as their concussion, no matter the level of sport.

There is little evidence in the literature on the timing of returning an athlete to sport.  There’s even less on returning an athlete to school or work, if their work isn’t their sport.  We usually want the athlete to be relatively symptom-free, and most importantly, to be free of any worsening of their symptoms when they exert themselves.

There is an important point to be made here. 

Exertion means any brain exertion – whether physical or mental.  That is, gaming, texting, Facebooking, watching TV, listening to music, even reading are all activities that use brain power, and therefore are considered “exertion”.  Many concussed athletes will complain of having worse headaches, dizziness, “fogginess” or nausea after they’ve done some of these activities.  When their symptoms are severe enough, particularly in the short period right after a concussion, we may pull kids out of school, or keep adults home from work, until their symptoms improve.  They’re told not to do any physical activity until we can get them back into their normal daily cognitive activities.

An interesting study at the University of Buffalo looked at patients who’ve suffered from post-concussive syndrome for many months.  Instead of rest, they put these patients through a carefully monitored, supervised exercise program, and they seemed to get better.  It was quite a small study, and so we have to be careful in interpreting those results, but it is one area that will require further research, and may hold some hope for those patients that are simply not getting better.

The sports medicine clinic I run in Toronto, Athletic Edge Sports Medicine, has just launched a concussion management program with diverse set of team members: neurosurgeon, sports medicine physicians, neuropsychologist, occupational therapist, clinical psychologist, and concussion educator.  This is, I think, the most comprehensive program in southern Ontario, and will provide excellent clinical care as well as generate research in the areas of concussion prevention and treatment.

Concussed athletes also have other injuries that commonly make their symptoms worse.  In particular, neck injuries often accompany head injuries, and can be a source of headache pain.  We often refer our concussed patients for manual therapy, acupuncture and exercises with our therapy team.

Finally, concussion can often be associated with depression.  This is not only a reaction to the loss of ability to go to school or work, or the loss of ability to play their sport, but concussions have a direct effect on the brain that can lead to emotional distress of one type or another.  Sometimes it manifests as irritability, anger or volatility.  Imagine the concussed brain as a computer that gets dropped.  Lots of functions may get scrambled, and the more programs that are run at the same time, the slower the computer will work, or the more errors will happen.

Clinical psychologists can play a significant role in coaching patients through the emotional aspect of concussion, and of course can also identify when an athlete is suffering from a clinical depression requiring further intervention.